Gref Syndrome

The symptom of the setting sun is a pathology that can occur at any age. Consider the features of the syndrome, symptoms, methods of diagnosis and treatment.

For the first time the disease was described in the nineteenth century by the German ophthalmologist Albert Gref. The scientist studied the state of bilateral paralysis of the eye muscles, which arises from the degeneration of nerve cells. This causes limited glance mobility, pupil dilatation, wrong position of the head and other pathological symptoms. The scientific medical name of the disease is hydrocephalic syndrome (HGS). It is associated with an excessive accumulation of cerebrospinal fluid in the ventricle of the brain or under its membranes.

[1], [2]

Causes of the gref syndrome

Hydrocephalic disorder indicates a pathological state of the brain. The causes of Gref's syndrome are associated with congenital or acquired factors that affect the child's undeveloped nervous system. Gradually the central nervous system adapts to the surrounding conditions and the symptomatology passes.

The main causes of pathology:

• Late, premature, complicated delivery.
• Pathological course of pregnancy.
• Infectious diseases during pregnancy.
• Chronic diseases of a woman.
• Hereditary factors.
• Hypoxic state.
• Ischemia.
• Bradycardia.
• Birth trauma.
• Cyst of the brain.
• Increased intracranial pressure.
• Metabolic disorders.

In these cases, the child is immediately registered with a neurologist to monitor the clinical picture. If the baby is premature, the defect of the eyeball may persist for a long period of time. In rare cases, HGS occurs in adulthood due to the accumulation of cerebrospinal fluid as a result of metabolic disorders, craniocerebral trauma, various infections.

[3]

Pathogenesis

The mechanism of developing the symptom of the setting sun is based on the inferior functioning of the nervous system. Pathogenesis depends on the cause of the pathological process, which is associated with the accumulation of cerebrospinal fluid. Cerebrospinal fluid accumulates in large quantities due to disruption of the system of its products and absorption. The total volume of cerebrospinal fluid in the subarachnoid space and ventricles is about 150 ml. During the day, the body produces up to 180 ml of cerebrospinal fluid. 75% of this volume produces vascular plexuses of the ventricles of the brain.

The rate of production depends on the perfusion pressure in the brain (the difference between intracranial and mean arterial pressure). The rate of fluid absorption depends on intracranial and venous pressure. All this points to the instability of liquorodynamics. An increase in cerebrospinal fluid in the skull may be the result of an equilibrium between its absorption and production or a disturbance in its normal outflow.

This pathology is characterized by a white band between the iris and the upper eyelid, which is visible when you look down. The syndrome has two varieties:

• It manifests itself with a change in the position of the body - it passes by itself for 2-3 months from the birth of the baby.
• Symptoms do not depend on the movements or position of the body - this condition requires medical care and thorough diagnosis.

For an accurate diagnosis, the child is prescribed MRI, CT, neurosonography and other studies. Based on their results, a therapy plan is prepared (medication, medical massage, physiotherapy procedures). If there is a positive dynamics, then limited to such treatment. In more complex cases, the patient is waiting for a surgical intervention to ensure the outflow of liquor.

[4], [5], [6], [7], [8],

Symptoms of the gref syndrome

Most often the syndrome manifests itself in premature babies, as their nervous system did not manage to get into a mature state, but it is possible in healthy babies in the first days of life. In 95% of cases, suspicions are not justified. The main sign of a malaise is a white band of sclera over the iris of the eye under the upper eyelid, which is noticeable when the child looks down. Many doctors are confident that such a condition is not dangerous and passes on its own, if there is no additional symptomatology. To make an accurate diagnosis, the doctor sends the patient to a number of diagnostic measures and tests. Based on their results, gives recommendations on treatment and prevention.

The symptoms of the disease depend on the patient's cause and age. Symptoms of Gref syndrome can appear from the first days of a child's life. As a rule, this is a complex of disorders that confirm the presence of pathology.

Symptoms:

• Slightly expressed reflexes in a baby (difficult to swallow, compress fingers).
• Weakened muscular system - the hands and feet hang when the baby is taken in hand.
• Frequent seizures.
• Pronounced strabismus.
• Frequent regurgitation.

The most important indicator of the development of the disease is nystagmus, that is, involuntary eye movements. This happens with a high frequency and amplitude. Movement is observed, both in horizontal and vertical position, with a visible band of the protein of the eye above the iris.

Due to the lack of oxygen in the tissue as a result of damage to the cardiovascular system, the skin of the extremities and the nasolabial triangle turns blue. Vegetosovascular disorders and blood supply problems provoke the marbling color of the skin. Against this background, the natural regulation of the body is disrupted, there is a rapid breathing. Gradually begins to rise intracranial pressure, and the brain is filled with cerebrospinal fluid. As the child's nervous system grows and strengthens, the production of cerebrospinal fluid normalizes, the fontanelle closes and intracranial pressure normalizes.

With the pathological development of patients of childhood, the cerebrospinal fluid penetrates into the venous system, provoking deafness, blindness, and a backlog in physical and mental development. Without treatment, the disease can develop into paralysis, to whom or epilepsy.

In patients of adult age, the symptoms of the syndrome look like this:

• Morning headaches, which are given to the forehead, the superciliary area and whiskey.
• Frequent attacks of nausea and vomiting.
• Dizziness.
• General weakness and lethargy.
• Difficulties in lowering the eyes and raising the head.

Because of the increased muscle tone of the lower limbs, the patient walks on the socks. There is drowsiness, strabismus, the thinking process gradually slows down, problems arise with concentration of attention and memory. If you have this symptom, you should immediately seek medical help. It is better to pass the examination once more than to miss the onset of a serious pathology.

[9],

First signs

The clinic of Gref's syndrome depends on the level of increase in intracranial pressure (hypertension) and the increase in the amount of cerebrospinal fluid in the brain (hydrocephalus). The first signs appear from the first days of the child's life. Parents note that the baby constantly cries, moans, badly takes the breast. The disease is characterized by such a complex of symptoms:

• Reduced muscle tone.
• Tremor of extremities.
• Slightly expressed congenital reflexes: swallowing, grasping.
• Strabismus.
• Frequent regurgitation of a fountain.
• White strip between the pupil and the upper eyelid.
• Disclosure of the seams of the skull and bulging fontanel.
• Increased head circumference (1 cm per month).
• Swelling of the visual discs.

In older patients, the disorder is manifested after a previous infection or brain injury. The first signs look like this: severe headaches in the morning, nausea and vomiting. The pains are bursting, dull, localized in the temples and forehead. Patients are difficult to raise their eyes and lower their head, possibly dizzy.

The above symptoms are accompanied by pallor of the skin, weakness and lethargy. Irritability appears on loud sounds and bright light. The syndrome can cause strabismus, delayed thinking and mindfulness, drowsiness. Increased muscle tone provokes walking on the socks.

[10], [11], [12], [13],

Gref's syndrome in newborns

Frequent tilting of the head back, plentiful regurgitation and wandering gaze are signs of Gref syndrome in newborns. Malady is associated with increased intracranial pressure and hydrocephalus. The kid suffers from severe headaches, against which strabismus, deafness develops and visual acuity worsens.

Very often pediatricians call the problem a symptom of the "setting sun". Since the infants in the upper eyelid lag behind the iris. This is noticeable when looking down, at the top appears a part of the sclera. As a rule, pathology is diagnosed in premature babies, since the nervous system is not able to control the processes in the eyeballs. But as soon as the nerve cells ripen, all the symptoms disappear. About 2% of healthy children are born with a syndrome, doctors associate it with hereditary predisposition and eye structure.

Such children need medical supervision. But if the disorder is accompanied by additional symptoms: pulsating fontanel, quiet crying, tremor of limbs, tipping of the head, frequent regurgitation, the kid is sent for diagnosis and treatment. For the detection of hypertensive-hydrocephalic disease, MRI, electroencephalography and other studies are needed. This will determine the presence of abnormalities and internal tumors.

To prevent further development of pathology, the patient is prescribed a special massage and other physiotherapy procedures to facilitate the condition. In especially severe cases, surgery is performed - bypass for the withdrawal of cerebrospinal fluid.

Gref Syndrome in adults

Hypertensive-hydrocephalic disorder in adults develops due to:

• Tumors.
• Neuroinfections.
• Postponed stroke.
• Craniocerebral injury.

Symptoms of Gref syndrome in adults are similar to those in children:

• Severe headaches.
• Visual disturbances (strabismus, double vision).
• Nausea, vomiting.
• Violations of consciousness.
• Problems with concentration, memory, mental activity.
• Convulsive attacks.
• Coma.

To diagnose and prescribe the treatment, the patient must undergo a full range of diagnostic procedures. Therapy consists of medication and physiotherapy. With timely access to medical care, the disease can be eliminated with minimal complications.

Complications and consequences

Gref's syndrome, like any other disease left without medical care, can cause serious consequences. Pathological disorders are manifested by all organs and systems, most often this:

• Delay of physical and mental development.
• Incontinence of urine and feces.
• Bulging fontanel.
• Blindness.
• Deafness.
• Epilepsy.
• Paralysis.
• Coma.
• Death.

These symptoms are possible in patients of any age who have been diagnosed with the disease. The most favorable outcome of the disease in infants. This is because the increase in blood pressure and cerebrospinal fluid stabilizes as you grow up. In adulthood, the appearance of adverse effects is more likely, but with timely treatment, the risk is minimal.

[14], [15], [16]

Complications

Diseases associated with disorders of the nervous system in patients of any age, entail serious complications. If the syndrome is detected in a baby, then there is a chance that as it gets older, everything will return to normal. But if this did not happen, the disease leads to problems with hearing and vision (strabismus), mental and physical development disorders.

With Gref's syndrome, spinal fluid enters the venous system. In this case, there are seizures of epilepsy, paralysis and even coma. A number of complications occur at advanced stages. To facilitate the patient's condition, shunting is performed for a better outflow of the CSF. Avoid serious complications can be provided timely diagnosis and treatment.

[17]

Diagnostics of the gref syndrome

Any violations, both in infancy and adulthood, require medical supervision. The cause for concern is the symptom of the setting sun. The defect is characterized by tension and protrusion of the fontanel, opening of the baby's skulls, swelling of the visual discs, rapid increase in the circumference of the head, frequent attacks of headache with nausea and vomiting, tremor of the extremities. To determine how dangerous this condition is, it is necessary to undergo a medical examination.

• Inspection from a neurologist - the doctor studies the development of the head: the level of closed joints, the condition of the fontanelle, the change in the size of the skull.
• Inspection from the oculist - the examination is aimed at examining the fundus to identify edema of the optic disc.
• MRI, ultrasound - allows to study in detail the patient's condition, causes and stage of the disorder.

Relying on the results of these methods, the doctor makes a course of treatment. The duration of therapy and its effectiveness depend on the patient's age, the presence of complications and the severity of HGS.

[18], [19], [20], [21]

Analyzes

The detection of hypertension-hydrocephalic syndrome is difficult, since the methods of research indicating the level of CSF pressure are limited. Blood and urine tests are a standard diagnostic kit that allows you to judge the general condition of the patient's body. A lumbar puncture of the cerebrospinal fluid for pressure measurement is mandatory. The results of this analysis serve as a diagnostic criterion of pathology.

The patient is assigned a neurosonography, that is, a study of the anatomical structures of the brain and the size of the ventricles. The doctor assesses the condition of the vessels of the fundus. The signs of the disease are: puffiness, vasospasm, fullness, hemorrhage.

[22]

Instrumental diagnostics

To clarify the causes and factors that caused the symptom of the setting sun, not only standard methods of research are used, but also instrumental diagnostics.

The hardware survey consists of:

• Neurosonography - uzi anatomical structures of the brain through the fontanel. Detects foci of leukomalacia, periventricular hemorrhage and ventriculomegaly.
• Echoencephalography - the study of intracranial lesions and processes of brain activity with the help of ultrasound. It has no contraindications, so it can be used for patients from an early age.
• Radiography of the skull - is used in advanced stages of the disease. Most often it is carried out for children older than a year.
• Rheoencephalogram - a study of venous outflow of cerebral vessels.
• Computer tomography - allows you to determine the size of the ventricles of the brain and the site of occlusion of the outflow of cerebrospinal fluid.
• Investigation of the fundus - determines the severity of abnormalities and the degree of pathological process. With mild deviations - moderate plethora of veins, with moderate - separate hemorrhages, enlargement and swelling of the veins, severe - hemorrhages, atrophy of the nipples of the optic nerves.

In addition to the above methods, the diagnosis of cerebrospinal fluid. Abnormalities indicate intracranial hemorrhage, possible red blood cells, macrophages in the cerebrospinal fluid.

Differential diagnosis

On the symptomatology the symptom of a setting sun is similar to other diseases arising because of disturbances of the central nervous system. Differential diagnosis allows you to separate the signs of the disease from other pathologies. GGS can act as a symptom of hydrocephalus or any other neurological lesion. In the differential examination, clinical signs are laid, indirectly indicating an increase in cerebrospinal fluid pressure and expansion of the ventricles of the brain.

• Particular attention is paid to the results of neurosonography. This method allows you to separate the symptoms of the disease from brain defects, hypoplasia, haloproencephaly.
• Computer tomography objectifies hypoxic changes in brain tissue in the structures of the cerebellum, brainstem, which are poorly defined in neurosonography.
• When differentiating, MRI is used to determine the degree of ventricular expansion, their multi-chamber and the place of obstruction of the CSF.

Difficulties arise when examining children in the first year of life, since the presence of fontanel and open seams of the skull gives a certain abrasion in the clinic of the GHS. A sharp increase in the circumference of the head can be associated with the opening of sutures and fontanel. Suspect the disease allows additional symptoms: bulging fontanelle, enlargement of the veins of the scalp, convulsions, atrophy of the optic nerves, drowsiness, vomiting, crying, poor reflexes of sucking and grasping. In some cases, there is a tense facial expression, a fixed position of the head.

During the examination, the fact that patients of any age can have transient fluctuations of cerebrospinal fluid and blood pressure is taken into account. Headaches, nausea and other symptoms may indicate a variety of functional and metabolic disorders of the brain, infectious or inflammatory diseases. The final diagnosis is possible when comparing clinical symptoms with diagnostic results, which confirm the presence of changes in the size of the ventricles of the brain.

Treatment of the gref syndrome

The methods of treatment for Gref's syndrome depend on the results of the diagnosis. Elimination of the disease involved neurosurgeons, neurologists and ophthalmologists. As a rule, treatment takes place in specialized neurological centers.

Treatment consists of:

• Drug therapy (diuretic, sedative and vascular drugs, medicinal herbs).
• Diet
• Manual therapy
• Invasive procedures and gymnastics

Patients under 6 months are referred for outpatient treatment. Patients are prescribed medication (diuretics, nootropics, sedatives), physiotherapy and massage. The therapy is long and takes 3-4 months. In older children and adults, treatment depends on the cause of the disorders. If the disease appeared as a result of neuroinfection, then antibiotic or antiviral therapy is performed. For brain tumors or craniocerebral trauma, surgical intervention is indicated.

Medications

Diseases of the central nervous system and the brain require careful diagnosis and proper treatment. From the results of therapy depends not only health, but the possibility of a full life of the patient. Medicines are selected by a doctor who is guided by the age of the patient and the causes of the pathology.

Consider the main drugs used in the Gref syndrome:

Diuretic, increasing the outflow and reducing the secretion of the cerebrospinal fluid.

1. Diakarb

Refers to the pharmacological category of saluretics that cause diuresis through the removal of certain electrolytes. The medicine is taken orally, the blood is found after 6-12 hours. It is excreted by the kidneys unchanged for 24 hours.

• Indication: sodium and water retention in the body. Swelling due to circulatory failure, cirrhosis, kidney failure, pulmonary-cardiac syndrome. Decrease in intraocular pressure, glaucoma (primary, secondary), epilepsy, emphysema, tetany, gout.
• The drug is released in the form of tablets that are taken orally. Patients are prescribed 100-250 mg 1-2 times a day. The course of treatment is 4-5 days. It is not used in diabetes mellitus, acidosis, adisson disease, during pregnancy, hypochlorauria, hypokalemia and hypochloraemia.
• It is transferred well, side effects occur when therapeutic doses are exceeded or because of long-term use of the drug. Patients can face attacks of drowsiness, dizziness, headaches, fatigue, allergic reactions. Symptomatic therapy is indicated for treatment.

With ineffective treatment with diacarbum and a progressive increase in the ventricles of the brain, the patient is shown hospitalization and a bypass operation.

Nootropics to improve blood supply in the brain.

2. Pyracetam

Enhances the synthesis of dopamine in the brain, raises norepinephrine. Beneficial effect on blood circulation and metabolic processes in the brain, stimulates redox processes, improves blood flow, increases energy potential. The medication is released in the form of injections, for intravenous administration. Active substances quickly penetrate into various fluids and tissues of the body, including the brain. It is not metabolized, excreted by the kidneys, the elimination half-life is 4 hours.

• Indications for use: pathological processes with the phenomena of cerebrovascular insufficiency. Changes in cerebral circulation, memory impairment and attention as a result of craniocerebral injuries. Neurotic and asthenoaddynamic depressive states, schizophrenia, cerebrosthenic, encephopopathic disorders.
• The drug is administered intravenously, the initial dosage is 10 g in severe conditions up to 12 g per day. Duration of therapy is from 2 weeks to 6 months. Contraindicated to use in acute liver failure, diabetes, allergic reactions in history, children under 1 year. In case of an overdose, there is insomnia, irritability, heart failure.
• Side effects: decreased concentration, anxiety, mental agitation, dizziness and headaches, nausea, vomiting, diarrhea, convulsions, tremor. For treatment it is necessary to reduce the dose of the drug and to conduct symptomatic therapy.

3. Actovegin

By increasing the accumulation of glucose and oxygen, activates the cellular metabolism. This leads to an increase in the energy resources of the cell and the acceleration of the metabolism of adenosine triphosphate. Strengthens the cerebral circulation.

• Indications for use: acute disorders of cerebral circulation, violations of peripheral circulation, trophic disorders, ulcers of various etiologies, burns, radiation injuries. Medication is prescribed for damage to the cornea and sclera,
• The method of administration and dosage depends on the form of the preparation and the medical indications. Orally take 1-2 drops 2-3 times a day, with intravenous or intra-arterial administration use 10-20 ml. The course of treatment lasts 5-15 days. Actovegin is contraindicated in case of intolerance to its active components, during pregnancy and lactation.
• Side effects: skin allergic reactions, increased sweating, fever. To eliminate these symptoms, it is recommended that you stop treatment and seek medical help.

4. Aspark

It has antiarrhythmic action, regulates metabolic processes, restores electrolyte balance. Serves as a source of potassium and magnesium. It is used for the treatment and prevention of hypokalemia and hypomagnesemia, with circulatory disorders, ventricular extrasystole, cardiac arrhythmias, atrial fibrillation paroxysms.

• The drug is available in the form of ampoules, tablets and a solution for infusion. Depending on the form of release, the doctor chooses the dosage and duration of treatment (an average of 8-10 days). It is not used for chronic renal failure, myasthenia gravis, hyperkalemia, hypermagnesia, violations of atrioventricular conduction of 2-3 degrees.
• In case of an overdose, there are signs of arterial hypotension, neuro-muscular transmission disorders, arrhythmia, convulsions. Side effects are manifested by attacks of nausea, vomiting, diarrhea. Possible abdominal pain, flatulence, dry mouth, increased sweating. For treatment, hemodialysis and peritoneal dialysis are performed.

Sedatives for the normalization of the nervous system.

5. Diazepam

Tranquilizer of benzodiazepine series, possesses hypnodised, anticonvulsant, anxiolytic and miorelaksiruyuschimi properties. Selectively stimulates the action of gamma-aminobutyric acid in the receptors of the reticular formation of the column of the brain. This leads to a decrease in excitation of the limbic system, the brain and the thalamus. Increases the stability of nerve tissue during hypoxia and pain threshold, has a dose-dependent effect on the central nervous system.

• Indications for use: neurotic states (anxiety, hysteria, reactive depression), organic lesions of the central nervous system, insomnia, spasms of skeletal muscles in trauma, spastic conditions associated with damage to the brain or spinal cord. Complex treatment of vertebral syndrome, myositis, arthritis, bursitis, angina pectoris.
• The drug is intended for oral use, regardless of food intake. Duration of therapy and dosage are selected individually for each patient. Elevated dosages cause oppression of cardiac activity, respiratory activity, agitation, coma.
• Side effects are manifested by many organs and systems. Patients face muscle weakness, emotional lability, reduced concentration of attention. Possible disturbance of the stool, nausea, vomiting, jaundice, skin allergic reactions. Diazepam can cause a withdrawal symptom and drug dependence.
• Contraindicated use with intolerance of active substances, with a propensity for myasthenia gravis, suicide, epilepsy and epileptic seizures in the anamnesis. The drug is not prescribed for glaucoma, hepatitis, spinal and cerebral ataxia, cardiac and respiratory failure.

6. Tazepam

Has a hypnotic effect, has anticonvulsant and anxiolytic properties. Interacts with benzodiazepine receptors, causing their excitation. This provokes inhibition in the central nervous system, increasing the sensitivity of gamma-aminobutyric acid receptors. Active substances act on the reticular formation, reduce neurologic symptoms.

• Indications for use: neurasthenia, anxiety, depression, anxiety, attacks of increased excitement, disturbed sleep, tension with abstinence. Tablets are taken orally, washed down with clean water. The daily dosage is 15-30 mg, for 3-4 doses.
• Contraindications: intolerance to the active components of the drug, glaucoma, dizziness, drug intoxication, coma, the first trimester of pregnancy and lactation, respiratory disorders, myasthenia gravis, and balance disorders.
• Side effects: drowsiness, fatigue, attacks of nausea, vomiting, diarrhea, dryness of the oral mucosa, insomnia, asthenia, muscle tremors, convulsions, attention deficit disorders, hypotension. To eliminate them, you must stop treatment and seek medical help.

The above drugs are designed for long-term use to eliminate Gref's syndrome. At severe attacks of a pathology there is an emergency treatment. The patient needs to raise his head at an angle of 30 ° and conduct dehydration therapy (1% lasix solution intramuscularly at a dose of 0.1 ml / kg per day, 25% magnesium sulfate solution intramuscularly at a dose of 0.2 ml / kg, diacarb and glycerol). Symptoms of decompensation show hospitalization in the neurological department.

Physiotherapeutic treatment

Therapy of hypertensive-hydrocephalic syndrome consists of a variety of methods. This allows a comprehensive approach to the elimination of the pathological condition. Physiotherapeutic treatment consists of such procedures:

1. Electrophoresis - the procedure is carried out with Euphyllin. The medication is injected into the collar zone to improve the supply of the brain, which needs oxygen. The drug normalizes the functioning of the brain vessels, providing a normal absorption of lymph. As a rule, patients are prescribed 10 procedures for 15-20 minutes.
2. Acupuncture - normalizes metabolic processes and the work of the nervous system, eliminates spasms of blood vessels.
3. Massage of the spine and cervical-collar zone - improves the outflow of venous blood from the cranial cavity. The course of therapy is 15-20 massages. Patients are assigned daily self-massage 2 times a day for 20 minutes:

• Palms are injected up and down from the nape of the neck and clavicles.
• Massive movements massaging the base of the skull (massage should cause moderate pain).
• Pads of fingers perform circular movements on the back of the neck, stroking the neck.

4. Physiotherapy exercises - swimming, walking, tennis, walking in the fresh air. Due to the dosed physical activity, the tonus of the cervicothoracic region rises, and muscle spasms leave. Depressed muscles can press on vessels that drain blood from the brain. The physiotherapist selects a set of exercises that improve the patient's well-being.
5. Magnet on the collar zone - such therapeutic procedures reduce the tone of the vessels and normalize intracranial pressure. Magnets reduce the sensitivity of brain tissue to oxygen deficiency, which arises from excessive accumulation of cerebrospinal fluid. The magnet has anti-edematous effect, reduces edema of nervous tissues.
6. Circular shower - a special shower unit directs to the skin a thin construction of water, which activate the receptors and exert a temperature effect. This improves blood circulation, increases muscle tone.

Regular execution of physiotherapy procedures normalizes the patient's condition and allows to minimize the pathological signs of Gref's syndrome.

Alternative treatment

To eliminate diseases of the central nervous system, both traditional and non-traditional methods are used. Alternative treatment refers to the latter. Such therapy is not approved by medicine, but in most cases helps to minimize painful symptoms. Such treatment improves cerebral circulation, reduces the amount of cerebrospinal fluid (intracranial fluid) and relieves headaches.

Consider alternative methods of treating the symptom of the setting sun:

• Tincture to restore the central nervous system and improve the cerebral circulation - mix in equal proportions leaves of valerian, hawthorn, mint, motherwort and eucalyptus. A tablespoon of the collection pour 500 ml of vodka and insist 7-10 days at room temperature. The drug must be filtered, squeezed and take 15-20 drops for 1-1.5 months.
• Means to reduce intracranial pressure - 2 lemons and a pair of cloves of garlic, crumble, fold in a glass jar and pour 1.5 liters of hot water. Ingredients should be mixed and insisted during the day in a dark place at room temperature. Strain, squeeze and take 2 spoons 1 time per day before going to bed for 14 days.
• Infusion, lowering intracranial pressure - 20 g of lavender grass, pour 500 ml of boiling water and insist for 1-1,5 hours, strain and take 1 spoonful once a day for 30 minutes before eating for a month.

Alternative methods are best used in consultation with a doctor. They are not used for patients of childhood to avoid negative reactions from many body systems.

[23], [24]

Herbal Treatment

Herbal medicine is one of the most effective methods of normalizing the functioning of the central nervous system and other body systems. Herbal treatment is carried out under medical supervision. With Gref syndrome, patients of all ages are prescribed herbs with sedative effect. Most often it is a cocktail of mint, hops, St. John's wort, sage and motherwort. Ingredients are mixed, insisted and taken as needed. This drug normalizes intracranial pressure.

Consider the popular herbal recipes:

• Grind the mulberry branches, and pour boiling water. The broth should be boiled over low heat for 30 minutes, cool and strain. Take 200 ml before eating.
• Grate lavender grass, and pour olive oil 1: 1. The drug should be infused for 20 days in a dark, cool place. After this, it is filtered, mixed with Kalanchoe juice 1: 1. The drug can be instilled in the nose or take inside 1-2 spoons.
• Mix the nettle with the string in equal proportions and fill with boiling water. The broth should be consumed before each meal.
• Dry leaves of plantain pour 500 ml of boiling water and cook over low heat for 10-15 minutes. A strained broth is taken 50 ml 3-4 times a day.
• Mix in equal proportions: seeds of dill, nettle, sporach, leaves of horse chestnut and corn stigmas. Collect the pour boiling water and boil over low heat for 10-20 minutes. After the product has cooled, it is filtered and taken before meals for 10-20 ml 2-3 times a day.

These recipes not only eliminate intracranial pressure, but also minimize the pathological symptoms of hydrocephalic disorder.

Homeopathy

Another method of non-traditional treatment of violations of the outflow of cerebrospinal fluid and the increased intracranial pressure caused by it is homeopathy. Drugs are selected by the attending physician, who examines the patient and studies the history of his illness.

Patients are assigned only granular means. Typically, this is Apis 6 (3 granules, regardless of meals in the first half of the day) and Sanguinaria 6 (5 pellets at bedtime). Therapy with homeopathic remedies is prolonged, but it allows to achieve a persistent therapeutic effect.

Operative treatment

Severe stages of Gref syndrome, in which drug therapy is not effective, require surgical intervention. Operative treatment has several types and depends on the age of the patient.

1. Shunting

This method involves the creation of an additional pathway for the outflow of liquor. The disadvantage of the operation is that if it is carried out in children, then the extent of their growth, it must be repeated.

• Indication - blockage of the pathways, hydrocephalus, cysts, causing an increased separation of the liquor fluid. The doctor conducts an intra-coliconeal discharge of cerebrospinal fluid from the ventricles of the brain into the abdominal cavity of the patient.
• Mechanism of action - as soon as the pressure rises above the norm, a valve opens in the cranium, releasing excess liquor into the tube system. The valve prevents the return of the liquid or the ingress of blood into it. Since the catheter has a small diameter, it can be damaged or clogged, which will require its re-installation.
• The course of the operation - a hole is made in the skull, into which a silicone catheter is inserted. One end of the tube is in the ventricle of the brain, and the other end is out. To divert the cerebrospinal fluid, a system of tubes and valves is provided, which is carried out under the skin.

2. Puncture

It removes excess cerebrospinal fluid and normalizes intracranial pressure. Provides outflow of cerebrospinal fluid from the ventricles of the brain, suitable for sampling fluid for analysis or medication administration.

• Ventricular - excess of liquor is removed through a long needle. Soft head tissues are cut and make a small hole in the skull. Through it, a catheter is inserted to a depth of about 5 cm. Once it reaches the right lateral ventricle, it is attached to a special reservoir, which is fixed 20 cm above the head. This allows you to maintain a normal level of pressure and remove cerebrospinal fluid.
• Lumbar - the advantage of this type of operation is that it has minimal risks of brain damage. The needle is inserted between 2 and 3 lumbar vertebrae with a previously used solution of novocain for anesthesia. Using a rubber tube cannula, the needles are connected to a reservoir to prevent bacteria from entering the cerebrospinal canal and fluid is withdrawn.

3. Endoscopic drainage operation

• Indication - the need to remove the shunting mechanism or complications of shunting operations, posttraumatic increase in intracranial pressure. The doctor conducts endoscopic perforation of the bottom of the third ventricle.
• Mechanism of action - with the help of an endoscope a channel is created between the subarachnoid cisterns and the bottom of the ventricle. This operation does not cause complications and does not require repeated procedures.
• The course of the operation - as an endoscope, a mechanism with micro instruments (scissors, forceps, catheter) is used that form a channel for the outflow of the cerebrospinal fluid in the bottom of the third ventricle to the brain cisterns.

Operative treatment is the only method of treatment for Gref syndrome caused by congenital pathologies, craniocerebral trauma or tumors.

Prevention

After the course of treatment of hypertensive-hydrocephalic syndrome, the patient is waiting for a long period of rehabilitation. Prophylaxis is aimed at restoring the functioning of the central nervous system and normal intracranial pressure.

• Day regimen - it is very important to alternate different types of loads. Rest, that is, sleep should be at least 7-8 hours. Avoid overheating, as increased temperature leads to high arterial pressure and increased production of cerebrospinal fluid. Raise the head of the bed at 30-40 °, this will improve the venous outflow from the cranial cavity.
• Physical activity - constant activity supports the body in tone. Patients of childhood are encouraged to visit the pool, walk more often outdoors. For adults - cycling, breathing exercises, yoga, fitness. Particular attention should be paid to massage, enough 20 minutes a day to warm up the stiff neck muscles.
• Diet is a balanced diet and drinking regimen. In a day, you need to drink 1.5-2 liters of purified water, eat every 3-4 hours in small portions. In the diet should be a minimum of fatty, fried, salty foods. Under the ban fall alcoholic beverages and confectionery products with trans fats. Proper nutrition prevents obesity, which is the prevention of increased intracranial pressure.

Preventive measures must be observed throughout life. This will improve the general condition of the body and strengthen the immune system.

[25], [26]

Forecast

The symptom of the setting sun, like any other CNS disease, with timely diagnosis and treatment has a favorable outcome. The prognosis depends on the stage at which the pathology was revealed, the age of the patient and the individual characteristics of his organism.

The syndrome of gref, left without medical assistance leads to a number of complications that worsen the quality of life and the prognosis for recovery. Negative consequences of the disorder can cause the patient's death or disability.

[27], [28]